Back to Insights and Updates for ProvidersJuly 2023

Update for acute inpatient facility readmissions

Tufts Health Direct  |  Tufts Health RITogether  |  Tufts Health Together  |  Uncategorized

Please be aware that for dates of service beginning Sept. 1, 2023, the readmission policies for Tufts Health Direct, Tufts Health Together, and Tufts Health RITogether identified on our Tufts Health Public Plans Inpatient Facility Payment Policy, which currently apply for diagnosis-related group (DRG) facilities, will be expanded to additionally apply to providers reimbursed at a case rate.

For DRG groups or providers reimbursed at a case rate, payment for an acute medical readmission to the same acute facility within 30 days may be denied if Tufts Health Plan determines that the readmission was due to a premature discharge or related to the previous admission, or that the readmission was for services that should have been rendered during the previous admission. If the second admission is determined to be a readmission, the higher DRG of the two admissions will be compensated.

For more information, please refer to the Inpatient Facility Payment Policy, which we have updated to reflect this change.

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